目的 观察高位结扎联合腔内激光治疗大隐静脉曲张的疗效。 方法 回顾性分析2008年4月-2009年4月采用高位结扎联合腔内激光治疗32例大隐静脉曲张患者的临床资料，并与2003年-2008年采用传统手术方法治疗的61例患者进行对照分析。 结果 采用高位结扎联合腔内激光治疗的患者1例伤口感染，1例手术后患肢疼痛，3例手术后3个月局部轻度曲张；其余患者下肢症状减轻或消失，手术后1个月复查时活动均无障碍，无下肢深静脉血栓形成，无下肢深静脉损伤发生。高位结扎联合腔内激光治疗与传统手术方法比较具有切口少、出血量小、手术时间短、恢复快、住院时间短、手术后并发症较少、复发率低等优点。 结论 高位结扎联合腔内激光治疗大隐静脉曲张是一种安全有效的治疗方法，与传统手术比较具有明显优势。
ObjectiveTo compare the effectiveness of radiofrequency ablation (RFA) combined with transilluminated powered phlebectomy (TIPP) vs. high ligation and stripping (HLS) combined with TIPP in patients with varicose veins of lower limbs.MethodsA retrospective analysis was made on the clinical data of 190 patients (206 limbs) of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018, of them 88 patients (96 limbs) in RFA combined with TIPP group and other 102 patients (110 limbs) in HLS combined with TIPP group. The treatment effectiveness and quality of life was assessed with venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) in three months and one year after surgery. Doppler ultrasound was used to evaluate the closure of great saphenous vein.ResultsBaseline characteristics were similar between the two groups (P>0.05). The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time, intraoperative bleeding, hospital stay time, postoperative bed time, resumption time of activities, as well as incidences of skin induration and limb numb (P<0.05). Occlusion rates of great saphenous vein in 3 months was 93.8% (90/96) in the RFA combined with TIPP group and 97.3% (107/110) in the HLS combined with TIPP group, and in one year was 91.7% (88/96) and 97.3% (107/110) respectively, there was no significant difference between the two groups at the same time point (P>0.05). The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in 3 months and 1 year follow up (P<0.05), but there was no significant differences between the two groups at the same time point (P>0.05).ConclusionsRFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs. Compared with HLS, RFA has the same good effectiveness and quality of life, but it has the advantages of short operation time, rapid postoperative recovery, and less postoperative complications.
Objective To investigate the clinical value of laparoscopic high ligation of hernia sac with constructed veress needle in the treatment of indirect inguinal hernia in children. Methods Ninety-one cases of pediatric indirect inguinal hernia who received treatment in Suqian People’s Hospital of Nanjing Drum-Tower Hospital Group from October 2014 to December 2015 were selected and randomly divided into two groups, cases of laparoscopy group (n=41) were treated by laparoscopic high ligation of hernia sac with constructed veress needle, and cases of tradition group (n=50) were treated with traditional open high ligation of hernia sac. Comparison of clinical effect between the 2 groups was performed. Results All the operations were successfully carried out, and there was no conversion to open surgery in laparoscopy group. Three cases were diagnosed as two-side inguinal hernia in laparoscopy group, who were diagnosed as one-side inguinal hernia before operation. The operation time, length of surgical incision, blood loss, and hospital stay of the laparoscopy group were all significantly less than those of the tradition group (P<0.05). The incidence of postoperative complications such as scrotal edema and scrotal hydrocele, incidence of testicular dysplasia, and the recurrence rate in the laparoscopy group were all significantly lower than those of the tradition group (P<0.05). Conclusions Laparoscopic high ligation of hernia sac with constructed veress needle in the treatment of indirect inguinal hernia in children has good application value, which has advantages of small surgical trauma, shorter hospital stay, faster recovery, and less postope-rative complications, and we can find out contralateral recessive hernia during operation and avoid the second surgery.
目的:探讨经腹腔修补术治疗小儿复发性斜疝的安全性和疗效。方法:总结分析了我院2005年4月至2009年3月30例经腹腔修补小儿复发性斜疝手术的临床资料。30例患儿均为男性,年龄(3.10±1.36)岁,全部证实为小儿腹股沟斜疝行疝囊高位结扎术后1年内复发仍为腹股沟斜疝者,其中包括嵌顿型斜疝4例。结果:30例患儿手术均获成功,平均手术时间(31.0±5.28)分,术中失血(10.85±4.56)mL,术后平均住院天数(6.5±1.38),术中均无精索及膀胱损伤,术后均无阴囊血肿及远端疝囊积液,术后随访至今,无一例复发。结论:经腹腔修补术治疗小儿复发性斜疝术具有术中出血少,损伤小,并发症少,术后复发率低等优点,是一种安全有效的治疗方式,值得基层医院推广。
目的 探讨应用小切口点状抽剥加高位结扎术治疗下肢浅静脉曲张的疗效。方法 选择我院2006～2010年期间经静脉造影确诊为下肢浅静脉曲张患者146例（共153条患肢），采用小切口点状抽剥小腿部曲张浅静脉（包括小隐静脉及交通静脉结扎），加大隐静脉高位结扎、分段抽剥术式治疗。结果 本组手术顺利，手术时间30～50min （平均38min），住院时间3～5d （平均3.5d）。术后随访121例，随访6个月～3年（平均1.6年），除1例术后复发外，其余疗效满意，无手术并发症发生。结论 小切口点状抽剥加高位结扎术治疗下肢浅静脉曲张具有操作方法简单、手术时间短、创伤痛苦小、术后恢复快、复发率低、术后美观等优点，在基层医院值得推广应用。
目的 探讨大隐静脉高位结扎及剥脱术后腹股沟切口淋巴瘘发生的原因和防治方法。方法 回顾性分析我院收治的120例(186条患肢)行大隐静脉高位结扎及剥脱术者中术后发生腹股沟切口淋巴瘘患者的临床资料，并对相关文献进行复习。结果 大隐静脉高位结扎及剥脱术后腹股沟切口淋巴瘘发生率为4.3%（8/186）。2例单侧腹股沟切口淋巴瘘患者扩创后予以碘伏纱布填塞创面，于第20天及第23天后淋巴瘘闭合，再行切口二期缝合，7 d后拆线； 3例双侧腹股沟切口淋巴瘘患者切口创面予以医用胶喷洒后碘伏纱布填塞，3 d后淋巴瘘全部闭合，切口二期缝合、加压包扎后7 d拆线。切口均愈合良好。结论 对腹股沟区股根部不恰当的广泛解剖及淋巴结切除的不规范与大隐静脉高位结扎及剥脱术后腹股沟切口淋巴瘘的发生密切相关。术前对大隐静脉准确定位，术中仔细操作、避免广泛剥离、避免切除肿大淋巴结是预防腹股沟切口淋巴瘘的有效措施。淋巴瘘发生后予以医用胶封堵是有效的补救措施。
ObjectiveTo evaluate optimal surgical timing of high ligation and ambulatory phlebectomy in treatment of primary great saphenous varicose vein. MethodsThe patients who met the inclusion criteria were divided into simple varicose vein (C2) group and soft tissue complications (C3-C4) group.All the patients were received high ligation and ambulatory phlebectomy.The surgery-related indexes,hospital costs,improvement of quality of life,postoperative recurrence rate were observed. ResultsAll the operations were successful.The operative time,the number of operative incision,and the hospital costs in the C2 group were significantly less than those in the C3-C4 group (P<0.05).The total postoperative complications rate in the C2 group was significantly lower than that in the C3-C4 group (P<0.05).The postoperative AVVQ score on month 3 in the C2 group was significantly lower than that in the C3-C4 group (P<0.05).The postoperative recurrence rate on month 3 had no statistical significance between these two groups (P>0.05). ConclusionsEarly stage (C2) is the optimal surgical timing of primary great saphenous varicose vein,benefits of surgery and health economics in early stage are significantly better than those in mid-advanced stage (C3-C4).It is suggested that surgery should be underwent at early stage in patients with primary great saphenous varicose vein.
ObjectiveTo systematically review the effectiveness and safety of laparoendoscopic single-site surgery (LESS) for varicocele. MethodsSuch databases as The Cochrane Library, MEDLINE, EMbase, CBM, CNKI, and WanFang Data were electronically searched for studies about LESS and traditional laparoscopy for varicocele till March 1st, 2013. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, meta-analysis was performed using RevMan 5.1 software. ResultsSeven RCTs involving 452 cases were included. The results of meta-analysis showed that, there was no significant difference between LESS and traditional laparoscopy for varicocele on post-operational complications (RR=0.57, 95%CI 0.26 to 1.27, P=0.17), duration of hospital stay (MD=-0.30, 95%CI-0.87 to 0.26, P=0.30), improvement of semen parameters, and blood loss. However, LESS had longer duration of operation (MD=11.26, 95%CI 3.62 to 18.90, P=0.004). ConclusionThe effectiveness and safety of LESS and traditional laparoscopy for varicocele are similar, and LESS could achieve more beautiful and natural effects which has longer surgery time on account of non-proficiency in surgery and equipment. Due to the limited quantity and quality of the included studies, the above conclusion requires to be proved by more high quality randomized controlled trials.
目的 总结单纯性大隐静脉曲张的治疗经验。方法 回顾性分析我院2007年3月至2009年11月期间采用改进高位结扎及剥脱术治疗单纯性大隐静脉曲张65例患者的临床资料。结果 本组患者手术时间45～127 min，平均54 min。住院时间5～8 d，平均6.8 d。所有切口均甲级愈合，肿胀不适、沉重感等症状消失，切口皮下无出血、瘀血、血肿，无皮肤麻木等并发症发生。术后随访2～33个月，平均26.9个月，无一例发生深静脉血栓形成，均按期拆线，效果良好，无复发。结论 改进高位结扎剥脱术治疗单纯性大隐静脉曲张疗效确切。
ObjectiveTo observe the efficiency of endovenous laser therapy combined with planning sucking operation in the treatment of great saphenous varicose veins. MethodsTotally 48 patients (60 limbs) were treated from May 2011 to May 2014 in general surgery department of our hospital. The main trunk of great saphenous vein was ablated by endovenous laser treatment; and the varicose veins in calf were resected by planning sucking operation. ResultsAll 48 patients (60 limbs) were cured without recurrent during 6-36 months followed-up. The operative time of each side was 18-43 min, the average operative time was 22.6 min; with 1-3 skin incisions. Hospital stay was 5-8 d, the average hospitalization time was 6.7 d. After operation, the varicose veins and the felling of swelling were disappeared, the pigmentation was reduced or disappeared. Local skin numbness showed in 6 cases and recovered in 3-7 months after operation. Felling of burns appeared in 2 cases, and was healed after treatment. Ankle swelling presented in 5 cases, and released in 6-13 d with related treatment. Different degree of subcutaneous bruising appeared without any hematoma, and recovered in 2-4 weeks. Two cases were lost during the followed-up. ConclusionsEndovenous laser therapy combined with planning sucking operation is safe and effective in the treatment of great saphenous varicose. It is worthy of promotion with minimum damage, less pain, fast recovery, no scars, shorter operative time, and shorter hospital stay.